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Ultrasound Quarterly - Current Issue

Ultrasound Quarterly - Current Issue
  1. Editor’s Introduction: Is the Radiology Model of Ultrasound Working?
    No abstract available

  2. Endoleak
    imageNo abstract available

  3. The Commoditization of Radiology: Are We Our Own Worst Enemy?
    No abstract available

  4. Sonographic Pulmonary Abnormalities in Fetuses With Hypoplastic Left Heart Syndrome and Intact Atrial Septum Undergoing Attempted Atrial Septostomy In Utero
    imageAbstract: Fetuses with hypoplastic left heart syndrome (HLHS) and intact atrial septum are a particular subset of HLHS neonates with high perinatal mortality. The reported mortality in these patients is 50% to 70%, even with prenatal diagnosis. Prenatal left atrial and pulmonary venous hypertension results in abnormal pulmonary vascular and parenchymal development. The goal of this study was to compare the sonographic appearance of the lungs in fetuses with HLHS/intact atrial septum to neonatal outcome and/or pathology in cases where in utero intervention was performed to open the atrial septum. We found that lung inhomogeneity on ultrasound corresponded to peripheral lymphatic dilatation at autopsy and was associated with a dismal prognosis even when in utero intervention was successful.

  5. Preoperative Axillary Lymph Node Evaluation in Breast Cancer: Current Issues and Literature Review
    imageAbstract: Axillary lymph node (ALN) status is an important prognostic factor for overall breast cancer survival. In current clinical practice, ALN status is evaluated before surgery via multimodal imaging and physical examination. Mammography is typically suboptimal for complete ALN evaluation. Currently, ultrasonography is widely used to evaluate ALN status; nonetheless, results may vary according to operator. Ultrasonography is the primary imaging modality for evaluating ALN status. Other imaging modalities including contrast-enhanced magnetic resonance imaging, computed tomography, and positron emission tomography/computed tomography can play additional roles in axillary nodal staging. The purpose of this article is (1) to review the strengths and weaknesses of current imaging modalities for nodal staging in breast cancer patients and (2) to discuss updated guidelines for ALN management with regard to preoperative ALN imaging.

  6. Literature Reviews
    No abstract available

  7. Risk Stratification For Axillary Lymph Node Metastases in Breast Cancer Patients: What Clinicopathological and Radiological Factors of Primary Breast Cancer Can Predict Preoperatively Axillary Lymph Node Metastases?
    imageAbstract: This study was to investigate clinicopathological features including immunohistochemical subtype and radiological factors of primary breast cancer to predict axillary lymph node metastasis (ALNM) and preoperative risk stratification. From June 2004 to May 2014, 369 breast cancer patients (mean age, 54.7 years; range, 29–82 years) who underwent surgical axillary node sampling were included. Two radiologists retrospectively reviewed clinicopathological features, initial mammography, and initial breast ultrasonography (US). Univariate and multivariate logistic regression analyses were used to evaluate associations between ALNM and variables. Odds ratio with 95% confidence interval and risk of ALNM were calculated. Among 369 patients, 117 (31.7%) had ALNM and 252 (68.3%) had no ALNM revealed surgically. On multivariate analysis, four factors showed positive association with ALNM: the presence of symptoms (P < 0.001), triple-negative breast cancer subtype (P = 0.001), mass size on US (>10 mm, P < 0.001), and Breast Imaging Reporting and Data System category on US (≥4c, P < 0.001). The significant risk of ALNM was particularly seen in patients with two or more factors (2, P = 0.013; 3, P < 0.001; 4, P < 0.001).The estimated risks of ALNM increased in patients with two, three, and four factors with odds ratios of 5.5, 14.3, and 60.0, respectively. The presence of symptoms, triple-negative breast cancer subtype, larger size mass on US (>10 mm), and higher Breast Imaging Reporting and Data System category on US (≥4c) were positively associated with ALNM. Radiologically, US findings are significant factors that can affect the decision making process regarding ALNM. Based on risk stratification, the possibility of ALNM can be better predicted if 2 or more associated factors existed preoperatively.

  8. Adenofibroma in the Uterine Cervix Manifesting as Multilocular Cystic Lesions
    imageAbstract: Uterine cervical adenofibroma, a very rare benign neoplasm, has rarely been reported in imaging features in the English literature. Herein, we describe a case of uterine cervical adenofibroma that was depicted as a multilocular cystic lesion with enhanced solid portions.

  9. The Value of Active Ultrasound Surveillance for Patients With Small Testicular Lesions
    imageAbstract: This study aimed to determine whether active ultrasound surveillance may obviate the need for surgical resection in selected patients with small testicular lesions (STLs). A retrospective 11-year review was conducted of adults who were diagnosed with an STL on scrotal ultrasonography and who either had orchiectomy or sonographic follow-up during a period of at least 3 months. A total of 101 subjects were enrolled. Ultrasound findings, clinical features, histopathology/follow-up imaging were recorded. Logistic regression analysis was performed to select independent risk factors for the diagnosis of malignancy. Seventeen (16.8%) subjects underwent immediate surgery, 8 (7.9%) of 101 underwent surgery after ultrasound follow-up, and 76 (75.3%) of 101 were followed with ultrasound only. The follow-up period ranged from 1 to 7 months in the 8 patients who ultimately underwent surgery after ultrasound follow-up and from 6 to 84 months in the 76 patients followed up with ultrasound only. All 15 malignant cases underwent immediate surgery without follow-up sonography. The frequency of lesions, either benign at surgery or stable on ultrasound, was 85.1% (86 of 101; 95% confidence interval, 77%–91%). Logistic regression analysis showed that lesion size was the only independent risk factor for malignancy in hypoechoic STLs (P < 0.05). Most of the STLs were stable on serial sonograms and likely benign. Active ultrasound surveillance may be an appropriate management strategy in patients with STLs.

  10. Luteoma of Pregnancy
    imageNo abstract available

  11. Carotid Intima-Media Thickness Manual Measurements: Intraoperator and Interoperator Agreements Under A Strict Protocol in a Large Sample
    imagePurpose: The aim of this study was to assess the intraoperator and interoperator agreement for manual measurements of intima-media thickness (IMT) performed under a strict carotid ultrasound technical protocol. Methods: Two blinded experienced operators independently performed an ultrasound examination at the distal common carotid of 242 subjects in the same patient's position, diastolic phase, probe type, zooming, and depth. Thirty-six subjects were reevaluated in another time point. Three different-angle manual measurements (IMTindiv) were obtained. Interoperator agreements for each IMTindiv, and their mean (IMTmean) and maximum (IMTmax) values, were assessed with the intraclass correlation coefficient and Bland-Altman analysis. Intraoperator agreement was tested taking advantage of the second ultrasound round in 36 subjects. Results: IMTmean agreements (intraoperator, 0.665–0.913; interoperator, 0.856–0.897) were higher than IMTmax (intraoperator, 0.435–0.793; interoperator, 0.631–0.718) and any IMTindiv (intraoperator, 0.355–0.676; interoperator, 0.590–0.717). Despite the small systematic error for IMTmean (intraoperator, ≤0.03; interoperator, ≤0.02 mm), at best of times, the sampling error size reached at least 0.28 and 0.25 mm for intraoperator and interoperator agreements, respectively, and was never less than 0.13 mm. Conclusions: Although IMTmean agreement is excellent under a strict protocol, limits of agreement might be too wide to consider carotid ultrasound a robust cardiovascular risk biomarker.

  12. Mantle Cell Lymphoma Presenting as a Subcutaneous Soft Tissue Mass With an Unusual Appearance
    imageNo abstract available

  13. Sonographic Diagnosis of Periorbital Dermoid Cyst
    imageAbstract: Periorbital dermoid cysts occur mainly in children. Sonography is useful for the noninvasive, nonionizing evaluation of soft tissue lesions in infants and children without requiring sedation or anesthesia. We report the sonographic appearance of 25 periorbital dermoid cysts and identified that all are avascular oval lesions located below the aponeurotic plane. Nonaggressive bone remodeling was present in 52% of the cases. These finding in pediatric periorbital lesions are highly suspicious of a periorbital dermoid cyst.

  14. Hepatic Kaposi Sarcoma Revisited: An Important but Less Commonly Seen Neoplasm in Patients With Acquired Immunodeficiency Syndrome
    imageAbstract: Hepatic Kaposi sarcoma (KS) is the most commonly seen hepatic neoplasm in patients with acquired immunodeficiency syndrome (AIDS), found in 34% of patients in an autopsy series. However, the incidence of hepatic KS has significantly declined since the advent of highly active antiretroviral therapy and is not as commonly seen on imaging. We present a case of hepatic KS in a patient with AIDS, which was initially mistaken for hepatic abscesses on computed tomography. We discuss the computed tomography, grayscale ultrasound, and contrast-enhanced ultrasound appearance of hepatic KS and how to distinguish this hepatic neoplasm from other common hepatic lesions seen in patients with AIDS.

  15. Testicular Microlithiasis in the Setting of Primary Extragonadal Germ Cell Tumor: A Case Series
    imageAbstract: The clinical significance of testicular microlithiasis (TM) in patients with primary extragonadal germ cell tumor (EGCT) is not well understood. When EGCT is suspected, sonographic and physical examination of the testicles should be performed to evaluate for testicular lesion or atrophy; negative testicular ultrasound with current technology virtually excludes the possibility of occult primary lesion. Although EGCTs are known to be associated with elevated level of serum tumor markers, the utility of tumor markers in the presence of TM is not well understood. Current guidelines for TM follow-up and management do not include any potential correlation between TM and primary EGCT, an association that should be addressed on future updates.

  16. Sonographic Findings and Diagnostic Pitfalls in Evaluation for Uterine Rupture in a Case of Fetal Demise and Prior Cesarean Delivery of Unknown Type
    imageAbstract: A 38-week pregnant patient with history of cesarean delivery was admitted to the hospital for induction of labor after diagnosis of fetal demise. When the clinical picture became concerning for uterine scar dehiscence, an ultrasound was ordered. After targeted ultrasound of the lower uterine segment, the sonographer initially reported thin but intact lower uterine segment and normal positioning of the fetus. By keeping a high level of suspicion, the radiologist analyzed the images submitted and found other clues suggesting possible dehiscence or rupture. Additional images were then obtained, ultimately demonstrating uterine rupture with fetus external to uterus.

  17. Primary Angiosarcoma of the Breast: A Case Report and Review of the Literature
    imageAbstract: Primary angiosarcoma of the breast is a rare entity. In this case report, we present a case of primary angiosarcoma of the breast in a young woman who presents with her entire right breast enlarged without skin coloration change or signs of mastitis. She recently stopped breastfeeding. This case report will review the literature and present the mammographic and sonographic findings including elastography.

  18. Adult-Onset Idiopathic Hypertrophic Pyloric Stenosis Associated With Osteoglophonic Dysplasia and HIV: Case Report and Review of Literature
    imageAbstract: Adult-onset hypertrophic pyloric stenosis (HPS) is a rare anomaly that can be idiopathic or related to underlying gastric pathology. We describe a case of a 25-year-old man with history of human immunodeficiency virus and osteoglophonic dysplasia who presented with pain and swelling at a gastrostomy site. Computed tomography and upper gastrointestinal barium swallow demonstrated gastric distention and stricture at the distal portion of the gastric antrum. An ultrasound detected HPS. The patient eventually required pyloromyotomy for treatment. Human immunodeficiency virus infection has numerous gastrointestinal ramifications, but HPS has not been identified as one. Osteoglophonic dysplasia has not been an established risk factor for HPS. Idiopathic HPS is extremely rare in adults, but should be considered in this population when patients present with gastric outlet obstruction.

  19. A Case Study of Hemochromatosis and Conflicting Point Shear Wave Measurements in the Assessment of Liver Fibrosis
    imageAbstract: There are multiple factors that affect the shear wave speed in the assessment of liver stiffness. In this case report, we present a case of hemochromatosis that has elevated liver stiffness suggestive of significant fibrosis or cirrhosis; however on liver biopsy, no fibrosis was identified. This article will discuss the possibility that liver iron deposition may affect SWE measurements of the liver, leading to inaccurate assessment of liver fibrosis. In these cases, a liver biopsy may be required for accurate liver assessment.

  20. Serial Lung Ultrasonography to Monitor Patient With Diffuse Alveolar Hemorhage
    imageAbstract: Diffuse alveolar haemorrhage (DAH) leads to acute respiratory failure. This is why it requires rapid diagnosis and implementation of appropriate treatment. The standard diagnosis of a patient with DAH includes laboratory tests, diagnostic imagining (X-ray of the chest, high-resolution computed tomography), and bronchoscopy with bronchoalveolar lavage. We present a description of 2 patients diagnosed with systemic connective tissue disease and DAH, monitored with the help of lung ultrasound. To our knowledge, this is the first description of the use of lung ultrasound in DAH in adult patients.

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